Ectopic pregnancy

An ectopic pregnancy is one that occurs outside the uterus. The commonest site for an ectopic pregnancy is the fallopian tube, which is a thin tube like structure. As the pregnancy growing in the tube cannot withstand the pressure due to the growing pregnancy, normally the tube gives way within 2 months of pregnancy leading to excessive bleeding within the abdomen. Because the pregnancy is not in the uterus, it cannot progress normally and must be removed. About 1 in 60 pregnancies are ectopic. A ruptured tubal pregnancy will cause major bleeding into the abdomen and can even cause death. The symptoms are typically pelvic pain (usually a sharp pain on one side) and vaginal bleeding. If the tube has ruptured, there may be shoulder pain, dizziness, or fainting. Since there may not be much warning, you should call your doctor if you have pain or bleeding.

Initially, an ectopic pregnancy may appear just as a normal pregnancy, with a missed menstrual period and symptoms such as sore breasts and nausea. However, there is often abnormal vagina bleeding which may occur at the time of (or a little later than) the expected period. Often, this bleeding is mistaken for a period. Pain of the side of the ectopic occurs commonly and may be associated with a feeling of light-headedness. Making the diagnosis on clinical examination is difficult and the only suspicious finding may be pain on internal examination. If the tube ruptures, the patient experiences severe abdominal pain, fainting and shock.

The treatment for an ectopic pregnancy varies according to how early the problem is detected. Sometimes the pregnancy if detected early can be removed from the tube using a laproscope. The pregnancy may be removed from the tube, or the tube may need to be removed if it is badly damaged.

Sometimes if this ectopic pregnancy is detected very early before it has grown in size, a drug (methotrexate) may be given to stop the growth of the pregnancy. The drug prevents further growth and your body will absorb the tissue over time. The efficacy of the treatment is monitored by blood tests and ultrasound.

Increased risk for an ectopic pregnancy
Women who have already had an ectopic pregnancy, who have a history of pelvic inflammatory disease (PID) or pelvic infections, have a history of infertility, or pelvic surgeries are at an increased risk for an ectopic pregnancy. The earlier the pregnancy is diagnosed the better is the prognosis.

Today, an ectopic pregnancy can be diagnosed very early using blood tests for HCG and through vaginal ultrasound. Both these tests need to be done simultaneously in order to interpret the results correctly. The beta-HCG test is a very specific 'marker' for pregnancy. This blood test is very sensitive and, if negative, virtually excludes any risk of a significant ectopic pregnancy. A positive HCG level confirms that the patient is pregnant, but does not provide information about the site of the pregnancy. A vaginal ultrasound allows the doctor to locate the gestational sac of the early pregnancy. Occasionally, the sac may be seen outside the uterus, making a positive diagnosis of the ectopic pregnancy on sonography. Often, however, the sac cannot be seen clearly in ectopic pregnancies, especially if it is in an early stage. Then, both the scan and HCG levels need to be studied.

Another blood test which can be helpful is the determination of the serum progesterone level, which is low in patients with ectopic pregnancies, as compared to normal pregnancies.